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Comment by jakobe | Hacker News Reader

I don't get how a cardiac stress test can cost 2000USD. You put someone on a home trainer, let them pedal for 20 minutes, and look at their EKG. It's usually performed by a nurse, and the doctor spends 30 seconds looking at the EKG (the analysis of the EKG is even partially automated).

If there was actual competition on the market, I'm sure a health service provider would find a way to perform the test for 75USD.

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People who have stress tests administered often have underlying cardiac or pulmonary disorders that can be aggravated.

A not insignificant subset of people doing stress tests can enter into hypotensive shock or even cardiac arrest, the facility has to be prepared to deal with adverse effects as those reactions can be fatal.

Yes - it pays to have a big defib (not one of the 'press button now' mall variety), an experienced and qualified staff member or 5 with high level CPR training, and some good cardiac event type drugs, and a load of proper monitoring gear (heart rate, BP, etc). While these things aren't especially cheap, they would pay off fairly quickly at a decent clinic, and I was involved in the purchase of most this stuff for sub $10k US recently for a clinic (but got a mall style defib as our needs are different). Staff would be the greatest cost. That said, at 2k per test, most expenses for the year would be paid of in the first week or 3 at a busy clinic surely?

$2000 isn't that ridiculous depending on the circumstances, but $75 is impossibly low with America's system. In Canada they bill ~$200 +/- 100 depending on the details. A comparable figure in the states (again factoring insurance non-payment issues and convenience factors, i.e. how soon you can get it, having facilities close by) would be reasonable at $800-$1500.

$2000 is utterly ridiculous for a stress test. I used to work as a neurology tech, mostly dealing with epilepsy. Our tests themselves could invoke seizures, and we frequently saw seizures anyway, which can be life threatening if not handled. We were a private department in a hospital - as techs, we knew enough first aid to keep the person alive and call for the crash cart.

$2000 might sound reasonable if every single patient required emergency attention, but in truth, far from it. Medical tests aren't meant to bring you to the brink of death, and are generally designed to keep you safe. It's not even worth pretending that $2k 'might' be worth it; it's just not. As for covering for insurance non-payment, isn't that chicken-and-egg? When a test costs ten times what it should? That would suggest that for each test that someone pays for, there are nine patients effectively getting it for free.

You're assuming the cost is $200. In Canada it can be up to 6 months (from my own experience) to get a stress test booking. In the states you can do it the next week. That gets a significant premium. Compare it to buying something on eBay from Hong Kong and waiting 5-8 weeks vs paying 4x and getting it right this second from Best Buy. At the end of the day you're going to get what you need either way but it's how long you're willing to wait.

$2000 is only for uninsured patients, and as has been demonstrated numerous times results in you getting shafted when it comes to pricing. A better problem to attack is reducing the amount of stress tests given, as they're often completely unnecessary. Ontario has recently decided to stop paying doctors who give unnecessary stress tests, resulting in ~5000 fewer tests given every year.

A good thing about socialised systems (don't get me wrong, there are plenty of problems too) is that they often have more protocol homogeneity. What this helps with is that best practice gets codified and protocols written. Then a clear pathway is made for clinicians to follow, with a review system to allow for improvements. Fragmented systems with owner operators (usually sub specialists) can have other motives ($) and little to zero feedback on care quality. Large systems with set protocols helps reduce unneeded tests. Getting the money saved put back into other parts of the system however, can be.... Tricky.

As someone living under a "socialist" system, let me tell you : "practice" is codified, yes. Best practice is not, unless some politician's kid or granddad has the disease/condition in question.

Someone I know needed a root canal treatment, and I found out that ... it's not covered - at all - under the national system. Nor is it covered under normal insurance except for a small token amount (< $250 equivalent, and yes it will cost $2k+ here too). And there is no way to get it done quickly, which makes no sense. We're talking about a root canal here. Delaying it at the point where it hurts will make things worse FAST. WTF ?

Hmm.. That's bad. I live in a country with socialised healthcare, and there is some dental care. Most isnt covered, but if its an accident or an emergency (such as bad pain), it will get done. Imperfect, yes.

Having been a medical technician, I'm aware of the cost of equipment, consumables, wages, rent, and so forth. The consumables in the bulk of stress tests are minimal - you're basically paying equipment and wages, and there's no real reason why a stress test should be an order of magnitude more than what I used to do (all my tests required vendor equipment). Where I worked had a two-week waiting period instead of a one-week, but there were spaces for emergencies. It's certainly not worth 10x more in order to chop your wait from 2 to 1 weeks.

That it's still $2k for uninsured patients is still very much the problem. It's not particularly mollifying that 'only some people' get hit with that bill. No-one should be fleeced simply because they're unwell.

I think a better tactic is to break the student cap. As long as the students remain high quality and there are facilities to train them, there is no reason to limit the number of graduates. It's basically cartel behaviour if that's happening. Doesn't solve things in the short term, though. This being said, in healthcare, there is no golden bullet. Fixing a failing system requires multitudinous tactics.

The hospitals just charge that because they can. What most people don't know is that you can often negotiate them down.

The word "cash" works wonders. 4-10x discounts.

If you're paying list price you're not even trying.

The problem is the the overwhelming majority of Americans don't know this. I've had this conversation with many people and almost all don't know that you can get your cost discounted and that you can usually get them discounted to the Medicare/Medicaid price (which you just need to discover by matching it to CPT codes).

My mom was told about a procedure that would have cost her $120k, in one question the price dropped to $30k. That's such an unfathomable discount that I think many people are ignorant because it sounds too good to be true. They end up thinking that it doesn't exist, there is some catch or that they probably don't qualify somehow.

Fwiw, I've asked this at two locations, mostly for curiosity's sake. In both cases, the cash price was about 50% higher than what would have been paid through insurance, which was 100% not covered by my insurance.

Their reason was that insurance companies usually pay a predictable amount, but people paying cash frequently stop paying and get punted to collection agencies, ending up with (significantly) less money actually going to the hospital.

I'll keep asking, but it's not that clear-cut.

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